use of intraperitoneal mersilene in the management of large ventral hernias

ABSTRACT

Large ventral hernias usually require prosthesis for a successful repair. Many prosthetic techniques have been described with extra-fascial, sub-fascial, and intra-peritoneal positioning. The present study was conducted to asses the value of Mersilene mesh intra-peritoneal placement in the management of large ventral hernias. This study included 15 female patients with large ventral hernias [myo-apponeurotic defect >/= 10cm in diameter]. Their ages ranged from 30 to 62 years with a mean of 42.8 years. Twelve patients had an incisional hernia, following midline incision [n=6], right subcostal incision [n=3], paramedian incision [n=2], and Mc Burney's incision [n=1]. Three patients had a huge paraumblical hernia. All patients were clinically evaluated, investigated and had their respiratory function tests assessed both pre-and post-operatively. Hernias were repaired using the intra-peritoneal technique of mesh [30x30 cm Mersilene] positioning with placement of the greater omentum between the mesh and the bowel whenever possible. Patients were followed-up for a mean of 11.5 months [range 8-18 months]. The size of the hernia defect at surgery ranged from 10x13 cm to 22x25 cm with a mean of 13x14 cm. The mean hospital stay was 8.5 days [range 7-10 days]. Post-operatively, one patient developed superficial wound infection and another developed a seroma. Both resolved spontaneously on conservative measures. None of the patients developed post-operative respiratory distress. No recurrence was encountered during the follow-up period. The technique of intra-peritoneal Mersilene mesh fixation in the treatment of large ventral hernias a'ppears to be simple, adequate and safe. It does not cause post-operative respiratory distress and does not necessitate dissection of the intermediate planes thus minimizing hematoma and seroma formation and the risk of sepsis